From the Research
Yes, a woman with a cystocele during pregnancy can typically deliver vaginally, as the presence of a bladder prolapse does not automatically require a cesarean section. However, each case should be individually evaluated by an obstetrician based on the severity of the cystocele, other pelvic floor issues, and the overall clinical picture.
Key Considerations
- The decision for vaginal delivery versus cesarean section should be made on a case-by-case basis, considering the severity of the cystocele and other factors such as the patient's overall health and preferences 1.
- During labor, healthcare providers may take extra precautions such as careful monitoring of bladder emptying, possibly using intermittent catheterization if needed.
- Some women find that pregnancy actually temporarily improves cystocele symptoms due to the enlarged uterus supporting the bladder.
- After delivery, pelvic floor physical therapy is often recommended to strengthen the supporting muscles.
- Women with severe cystoceles may need to discuss delivery options more thoroughly with their healthcare provider, as there is a theoretical risk that vaginal delivery could worsen the condition, though this must be balanced against the risks of cesarean delivery.
Evidence-Based Recommendations
- A study published in 2020 in the journal BMC Pregnancy and Childbirth reported a case of a woman with unrepaired ectopia vesicae who had two successful vaginal deliveries without any symptoms or signs of pelvic organ prolapse 1.
- Another study published in 2020 in The Cochrane Database of Systematic Reviews found that pessaries (mechanical devices) can be effective in managing pelvic organ prolapse in women, but the evidence is uncertain regarding their effectiveness compared to no treatment or pelvic floor muscle training 2.
- A study published in 2018 in the journal European Urology compared the safety of vaginal mesh surgery versus laparoscopic mesh sacropexy for cystocele repair and found that laparoscopic mesh sacropexy is a valuable option for primary repair of cystocele, offering equivalent success rates to vaginal mesh procedures but with a lower rate of complications and reoperations 3.
Conclusion Not Applicable
Instead, the focus is on providing evidence-based recommendations for the management of cystocele in pregnancy, prioritizing morbidity, mortality, and quality of life as outcomes. The decision for vaginal delivery versus cesarean section should be made through shared decision-making between the patient and her healthcare team, taking into account the individual patient's circumstances and preferences.